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The role and functions of community-based multidisciplinary teams in two integrated care and support Pioneers: perspectives from local system leaders
No full textObjectives Central government has been promoting closer integration between the National Health Service (NHS) and local government social services in England for more than five decades. Improved coordination between primary, hospital, community health and social services has been advocated as a cost-effective response to growing care needs in an ageing population. This paper concentrates on one of the principal local care coordination mechanisms: community-based multidisciplinary teams (MDTs) involving NHS and social services staff. It reports local leaders’ perceptions of MDTs’ current and future contributions to more coordinated care and support systems in two integrated care Pioneer sites. Methods Thirty-two qualitative semi-structured interviews with 25 local system leaders and operational managers in two contrasting Integrated Care and Support Pioneer areas were conducted between October 2018 and April 2021, as part of a wider evaluation of the Integrated Care and Support Pioneer Programme. Eight of those interviews took place after the start of the COVID-19 pandemic and between lockdowns. Interviews were analysed thematically. Results Local leaders in both areas broadly shared a vision of integrated care in which MDTs were essential mechanisms for coordinating improvements in health and wellbeing, especially for older people who are frail, experience falls and have long-term health conditions. Organisational differences between and within sites influenced local decisions about the purpose and structure of MDTs, but, despite such variations, interviewees identified similar challenges to implementation. Staff turnover, often linked to funding uncertainties, and the lack of shared information systems, were among the most frequent operational challenges noted. System leaders valued national policy frameworks as potential enablers of integrated care but also recognised the role of local contexts in shaping local implementation decisions. Interviewees highlighted benefits emerging from multidisciplinary working, including its potential to deliver more holistic care, fewer instances of work duplication, speedier access to care and enhanced home care provision. However, they were concerned such benefits were not always captured by commonly used performance indicators and thus the value of MDTs could be under-estimated. Conclusions Local contextual variables and local understandings of these variables appeared to be the main influences on variations in local responses to national expectations of improvements in care integration. Local leaders in both areas broadly shared a vision of integrated care in which MDTs provided essential mechanisms for securing interdependent improvements in both the health and wellbeing of local populations and improvements in workforce job satisfaction
The views of older people on community-based multi-disciplinary team caseloads and informal carers about health and care services in two Integrated Care Pioneer sites in England
No full textObjectives: Community-based multi-disciplinary teams (MDTs) were among the most widely reported health and care integration initiatives in the Integrated Care Pioneers in England. Such MDTs bring together staff from different sectors to co-ordinate and plan care for patients, who are often older, have multiple long-term conditions and risk hospital admission. As part of our evaluation of MDTs in two contrasting Pioneers, we explored MDT patients' and informal carers' perspectives on health and care services. As the COVID-19 pandemic started during data collection, we also wanted to understand its impact on patients' access to services. Methods: We conducted qualitative interviews with 44 patients aged 60 or over, with long-term conditions, and on the caseload of one of 11 participating MDTs. We also undertook qualitative interviews with 15 carers. Interviews took place between November 2019 and March 2021. Interview transcripts were coded in NVivo-12 and analysed thematically. Results: In addition to formal services, patients often relied on informal care. Valued aspects of care included equipment and home modifications that supported independence, timely access to and continuity in care, effective information-sharing, professionals who made them feel that their needs mattered, and having a named contact. Where challenges were experienced (e.g. with accessing professionals, communication, and care quality), patients and carers sometimes felt abandoned. While some patients mentioned being on an MDT caseload, few reported having a care plan. The impacts of caring on informal carers were sometimes considerable. COVID-19 affected patient and carer wellbeing, but the new ways of accessing care generated by the pandemic were valued by some participants. Conclusions: As long as challenges remain, patients and carers are unlikely to perceive care as joined-up and patient-centred. If truly integrated and holistic care is to be provided, barriers (such as the lack of shared patient records) must be addressed. Even where MDTs function primarily to co-ordinate rather than deliver care, they could better communicate their co-ordinating role, and MDT discussion outcomes, including care decisions, to patients. Informal carers' needs also require greater attention by MDTs
Using online reviews to drive person-centered care: an HCAHPS-validated approach
No full textPerson-centered care focuses on the needs of the individual receiving care, and involves cooperation between patients and health professionals to develop and monitor care. This research demonstrates that online patient reviews provide a rich, real-time, and detailed source of patient experience that can be used for this purpose. This study also shows that unstructured online data can be quantified using machine learning and natural language processing to automatically flag and rate patient reviews. We describe a supervised learning approach, training a model on a large dataset of manually annotated patient reviews. We report model scores of 99% accuracy in predicting overall score, and 93% to 99% in predicting relevance to seven domains of patient experience, such as Effective Treatment, Fast Access, and Emotional Support. Furthermore, we show statistically significant alignment between these aggregated online patient reviews and HCAHPS star ratings—a “gold-standard” measure of care quality for hospitals in the United States. This approach enables benchmarking between health systems and evaluating the impact of interventions on patient experience, while quantifying and enhancing the patient-centeredness of care
Correlation concern
No full textIn many choice problems, the interaction between several distinct variables determines the payoff of each alternative. I propose and axiomatize a model of a decision maker who recognizes that she may not accurately perceive the correlation between these variables, and who takes this into account when making her decision. She chooses as if she calculates each alternative's expected outcome under multiple possible correlation structures, and then evaluates it according to the worst expected outcome
Digital development: reimagining research beyond ICT4D
No full textThis editorial introduces a conceptual framework that reimagines research on Information and Communication Technologies for Development (ICT4D) as “digital development,” recognizing the inseparable intertwining of digital and development trajectories. This framing is aimed at the broader information systems (IS) research community, which includes ICT4D researchers, based both in the Global South and the Global North. Digital development encompasses three dimensions: digital in development (institutional use), digital for development (conscious design for outcomes), and development in a digital world (digital entanglement in development practice.). We argue that this reimagination is necessary for three reasons. First, digital technologies are becoming increasingly entangled with many development initiatives, implying the need to be studied as a duality, not a dualism. Second, we are witnessing the rising complexity of contemporary and emergent development challenges, which are not just limited to the Global South, but to the world at large. Third, the IS and ICT4D research fields have long worked in relative isolation from each other, but they need to synergistically create new theories and methods to address the rising complexities inherent in the “digital” and “development.” We provide a brief overview of the existing ICT4D field to identify critical areas for reconceptualization and expansion. This is then illustrated by examples from four empirical domains, namely humanitarian governance, global health, financial inclusion, and digital nomadism, which are representative of contemporary and emerging digital development challenges. This leads to the development of theoretical, policy and practice, and methodological implications, which provide a basis to formulate a research agenda for digital development
Perpetual American compound fixed-strike lookback options on maxima drawdowns
No full textWe present closed-form solutions to the problem of pricing of the perpetual American compound lookback options on the maximum drawdown with fixed strikes in the Black-Merton-Scholes model. It is shown that the optimal exercise times are the first times at which the underlying risky asset price process reaches either lower or upper stochastic boundaries depending on the current values of its running maximum and maximum drawdown processes. The proof is based on the reduction of the original double optimal stopping problem to a sequence of two single optimal stopping problems for the resulting three-dimensional continuous Markov process. The latter problems are solved as the equivalent free-boundary problems by means of the smooth-fit and normal-reflection conditions for the value functions at the optimal stopping boundaries and at the edges of the three-dimensional state space. We show that the optimal exercise boundaries are determined as the maximal and minimal solutions to the appropriate first-order nonlinear ordinary differential equations
Reporting guideline for chatbot health advice studies: the Chatbot Assessment Reporting Tool (CHART) statement
No full textThe Chatbot Assessment Reporting Tool (CHART) is a reporting guideline developed to provide reporting recommendations for studies evaluating the performance of generative artificial intelligence (AI)-driven chatbots when summarizing clinical evidence and providing health advice, referred to as chatbot health advice studies. CHART was developed in several phases after performing a comprehensive systematic review to identify variation in the conduct, reporting, and method in chatbot health advice studies. Findings from the review were used to develop a draft checklist that was revised through an international, multidisciplinary, modified, asynchronous Delphi consensus process of 531 stakeholders, three synchronous panel consensus meetings of 48 stakeholders, and subsequent pilot testing of the checklist. CHART includes 12 items and 39 subitems to promote transparent and comprehensive reporting of chatbot health advice studies. These include title (subitem 1a), abstract/summary (subitem 1b), background (subitems 2a,b), model identifiers (subitems 3a,b), model details (subitems 4a-c), prompt engineering (subitems 5a,b), query strategy (subitems 6a-d), performance evaluation (subitems 7a,b), sample size (subitem 8), data analysis subitem 9a), results (subitems 10a-c), discussion (subitems 11a-c), disclosures (subitem 12a), funding (subitem 12b), ethics (subitem 12c), protocol (subitem 12d), and data availability (subitem 12e). The CHART checklist and corresponding diagram of the method were designed to support key stakeholders including clinicians, researchers, editors, peer reviewers, and readers in reporting, understanding, and interpreting the findings of chatbot health advice studies
Recovering the good life: enhancing the underlying political determinants for social rights enjoyment in the UK
No full textIn the UK, rights of political speech and freedom of expression have become antagonistically subversive of well-being, diminishing rather than assisting in the improvement of the life chances of voters and others. These rights have become separated from their original rationale, as the vital oil in the machine of representative democracy, and become instead wild actors existing outside the framework to which they belong and to which they should be subjugated. Pulled away from their function in this way and reified into decontextualised unchallengeable goods, such rights have become the creatures of depoliticised material power. The change is the result of structural defects that have been intrinsic to the UK political system since the onset of democracy. These vulnerabilities were held in check during the Cold War, but have exploded into view in the decades after its end in 1989. The problem is now so severe that it threatens the UK’s system of parliamentary democracy
Media platforming and the normalisation of extreme right views
No full textAs extreme political views gain popularity and acceptability, the conditions under which media exposure to extreme right views contributes to this process, and strategies to counter media-induced persuasion and normalisation effects remain unclear. Using population-based survey experiments leveraging real-world interviews with extreme right activists on Sky News UK and Australia, we test whether media exposure leads to higher agreement with extreme right statements. We also test whether exposure affects perceptions of how many others agree with these statements. Our findings are consistent across both countries: exposure to uncritical interviews increases agreement with extreme statements and perceptions of broader support in the population. Testing the media strategy in the UK, we find that critical interviewing tarnishes the activist’s image and reduces effects, but still heightens perceived support for extreme statements. This study identifies a mechanism through which extreme political ideas spread and offers insights into media strategies to counteract persuasion and normalisation effects
On the stability of racial capitalism
No full textWhat is the connection between capitalism and racial hierarchy? In line with the tradition known as ‘the theory of racial capitalism’ we show that the latter can functionally support the former. As a social construction, race has just those features which allow it to facilitate the sort of stable, inequitable distributions of resources that tend to emerge in capitalist systems. We support this claim using techniques from evolutionary game theory and cultural evolutionary theory, and end by discussing the normative political consequences of this relationship